Joint recommendations for reporting carotid ultrasound investigations in the United Kingdom.

At present in the United Kingdom a number of different criteria are used to grade disease in carotid ultrasound investigations. One main cause of this has been the difference in the method of grading angiograms used in the NASCET and ECST large carotid surgery trials. It is desirable that all centres reporting carotid ultrasound investigations report to the same standard. This paper presents recommendations for the reporting of ultrasound investigations of the extra cranial arteries produced by a Joint Working Group formed between the Vascular Society of Great Britain and Ireland, and the Society for Vascular Technology of Great Britain and Ireland. The recommended criteria are based on the NASCET method of grading carotid bulb disease. Key recommendations include recording peak systolic velocity (PSV) and end-diastolic velocity (EDV) in both internal and distal common carotid arteries; measuring all velocities at a Doppler angle of 45-60 degrees; the use of internal carotid PSV of >1.25 ms(-1) and >2.3 ms(-1) and a Peak Systolic Velocity Ratio of >2 and >4 to indicate >50% and >70% stenosis respectively; and the use of the St Mary's Ratio to grade >50% stenoses in deciles. General recommendations are also given for the acquisition, interpretation and reporting of the data.

[1]  G M Hathout,et al.  Ability to use duplex US to quantify internal carotid arterial stenoses: fact or fiction? , 2000, Radiology.

[2]  A. Fox,et al.  Carotid Stenosis Index Revisited With Direct CT Angiography Measurement of Carotid Arteries to Quantify Carotid Stenosis , 2007, Stroke.

[3]  B. Gosink,et al.  Carotid duplex sonography: bisferious pulse contour in patients with aortic valvular disease. , 1991, AJR. American journal of roentgenology.

[4]  J. Krejza,et al.  Effect of endogenous estrogen on blood flow through carotid arteries. , 2001, Stroke.

[5]  Peter M. Rothwell,et al.  Major Variation in Carotid Bifurcation Anatomy: A Possible Risk Factor for Plaque Development? , 2001, Stroke.

[6]  D. DeLong,et al.  Variability of Doppler US measurements along the common carotid artery: effects on estimates of internal carotid arterial stenosis in patients with angiographically proved disease. , 2000, Radiology.

[7]  Mark Stevenson,et al.  Accurate, practical and cost-effective assessment of carotid stenosis in the UK. , 2006, Health technology assessment.

[8]  W H Baker,et al.  An approach for the use of Doppler ultrasound as a screening tool for hemodynamically significant stenosis (despite heterogeneity of Doppler performance). A multicenter experience. Asymptomatic Carotid Atherosclerosis Study Investigators. , 1996, Stroke.

[9]  M. Eliasziw,et al.  The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. , 2000, The New England journal of medicine.

[10]  A. Buchan,et al.  *North American Symptomatic Carotid Endarterectomy Trial (NASCET) Steering Committee. Beneficial Effect of Carotid Endarterectomy in Symptomatic Patients with High-Grade Carotid Stenosis. , 1991 .

[11]  Chi-shin Hwang,et al.  Measurement of Carotid Stenosis: Comparisons Between Duplex and Different Angiographic Grading Methods , 2003, Journal of neuroimaging : official journal of the American Society of Neuroimaging.

[12]  Nonstenotic internal carotid arteries: effects of age and blood pressure at the time of scanning on Doppler US velocity measurements. , 2001, Radiology.

[13]  Muharrem Tola,et al.  Effect of Doppler Angle in Diagnosis of Internal Carotid Artery Stenosis , 2006, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[14]  M. Eliasziw,et al.  Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis , 2003, The Lancet.

[15]  C. Warlow,et al.  MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis , 1991, The Lancet.

[16]  P L Allan,et al.  Ultrasound assessment of internal carotid artery stenosis. , 1997, Clinical radiology.

[17]  A. Alexandrov,et al.  Grading carotid stenosis with ultrasound. An interlaboratory comparison. , 1997, Stroke.

[18]  M Williams,et al.  Angiographic and Duplex Grading of Internal Carotid Stenosis: Can We Overcome the Confusion? , 1996, Journal of endovascular surgery : the official journal of the International Society for Endovascular Surgery.

[19]  T. Jogestrand,et al.  Duplex ultrasonography is an efficient diagnostic tool for the detection of moderate to severe internal carotid artery stenosis , 2007, Clinical physiology and functional imaging.

[20]  E. R. Jewell,et al.  Carotid Duplex with Contralateral Disease: The Influence of Vertebral Artery Blood Flow , 2000, Annals of vascular surgery.

[21]  K. Khaw Does carotid duplex imaging render angiography redundant before carotid endarterectomy? , 1997, The British journal of radiology.

[22]  J. Marek,et al.  Evaluating institutional variability of duplex scanning in the detection of carotid artery stenosis. , 1998, American journal of surgery.

[23]  N. Thomas,et al.  The impact of theoretical errors on velocity estimation and accuracy of duplex grading of carotid stenosis. , 2002, Ultrasound in medicine & biology.

[24]  P J Breslau,et al.  A simple parameter for accurate detection of severe carotid disease , 1982, The British journal of surgery.

[25]  P. Hoskins A review of the measurement of blood velocity and related quantities using Doppler ultrasound , 1999, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[26]  David A. Steinman,et al.  Effect of Contralateral Carotid Artery Stenosis on Carotid Ultrasound Velocity Measurements , 2000, Stroke.

[27]  S. A. Gutnikov,et al.  Reanalysis of the Final Results of the European Carotid Surgery Trial , 2003, Stroke.

[28]  R. Peto,et al.  Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial , 2004, The Lancet.

[29]  P. Rothwell,et al.  Interrelation between plaque surface morphology and degree of stenosis on carotid angiograms and the risk of ischemic stroke in patients with symptomatic carotid stenosis. On behalf of the European Carotid Surgery Trialists' Collaborative Group. , 2000, Stroke.

[30]  A. Davies,et al.  Endarterectomy for asymptomatic carotid artery stenosis , 1995, BMJ.

[31]  K. Jong,et al.  Extracranial carotid artery aneurysms. , 1989, European journal of vascular surgery.

[32]  G. Sicard MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or mild (0–29%) carotid stenosis: European Carotid Surgery Trialist' Collaborative Group. Lancet 1991;337:1235-43 , 1992 .

[33]  A. Fox,et al.  Quantification of carotid stenosis on CT angiography. , 2006, AJNR. American journal of neuroradiology.

[34]  Theresa Fail Cardiovascular haemodynamics and doppler waveforms explained , 2002 .

[35]  K. W. Marich,et al.  Carotid duplex sonography: a multicenter recommendation for standardized imaging and Doppler criteria. , 1988, Radiographics : a review publication of the Radiological Society of North America, Inc.

[36]  S. Gutnikov,et al.  Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis , 2003, The Lancet.

[37]  The ratio of peak systolic velocity of internal carotid over end diastolic velocity of common carotid (PSVica/EDVcca): new duplex criteria for grading internal carotid stenosis , 1997 .

[38]  D. Charlesworth,et al.  Variability in measurement of internal carotid artery stenosis by arch angiography and duplex ultrasonography--time for a reappraisal? , 2001, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[39]  M G Hunink,et al.  Detection and quantification of carotid artery stenosis: efficacy of various Doppler velocity parameters. , 1993, AJR. American journal of roentgenology.

[40]  Ultrasound based measurement of 'carotid stenosis >70%': an audit of UK practice. , 2006, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[41]  Mark E. Schafer,et al.  The Methods and Effects of Transducer Degradation on Image Quality and the Clinical Efficacy of Diagnostic Sonography , 2003 .

[42]  Christopher K. Zarins,et al.  Duplex Ultrasound Criteria for Defining the Severity of Carotid Stenosis , 2002, Annals of vascular surgery.

[43]  J. Polak,et al.  Duplex ultrasound criteria for the identification of carotid stenosis should be laboratory specific. , 1997, Stroke.

[44]  D. Sackett,et al.  Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. , 1991, The New England journal of medicine.

[45]  R Eugene Zierler,et al.  Carotid artery stenosis: gray-scale and Doppler US diagnosis--Society of Radiologists in Ultrasound Consensus Conference. , 2003, Radiology.

[46]  J. Slattery,et al.  Equivalence of Measurements of Carotid Stenosis: A Comparison of Three Methods on 1001 Angiograms , 1994, Stroke.

[47]  K. Burnand,et al.  Effect of contralateral disease on duplex measurements of internal carotid artery stenosis , 2000, The British journal of surgery.

[48]  A. Alexandrov,et al.  Carotid Artery Stenosis: Grayscale and Doppler Ultrasound Diagnosis—Society of Radiologists in Ultrasound Consensus Conference , 2003, Ultrasound quarterly.

[49]  Peter M. Rothwell,et al.  Sex Differences in Carotid Bifurcation Anatomy and the Distribution of Atherosclerotic Plaque , 2001, Stroke.

[50]  P. Rothwell,et al.  Low risk of ischemic stroke in patients with reduced internal carotid artery lumen diameter distal to severe symptomatic carotid stenosis: cerebral protection due to low poststenotic flow? On behalf of the European Carotid Surgery Trialists' Collaborative Group. , 2000, Stroke.

[51]  C. Blomstrand,et al.  Influence of poststenotic collateral pressure on blood flow velocities within high-grade carotid artery stenosis: differences between morphologic and functional measurements. , 2001, Journal of vascular surgery.

[52]  S. Debus,et al.  Colour flow Doppler ultrasound of the carotid bifurcation: can it replace routine angiography before carotid endarterectomy? , 2001, The British journal of radiology.